		<div class="row">
		    <div class="col-xs-12">
		        <div class="box box-primary">
		            <div class="box-header">
		                <h3 class="box-title">Tambah Data Kelurahan</h3>
		            </div><!-- /.box-header -->
		            <?php echo form_open('master_kelurahan/save', array('role' => 'form', 'id' => 'form'));?>
		            <div class="box-body">				        
	                    <!-- text input -->
	                    <div class="form-group">
	                        <label>Kode Kelurahan</label>
	                       	<input class="form-control input-sm" name="kd_kelurahan" type="text" placeholder="Kode kelurahan">
	                    </div>
	                    <div class="form-group">
	                        <label>Kelurahan</label>
	                       	<input class="form-control input-sm" name="kelurahan" type="text" placeholder="Nama kelurahan">
	                       
	                    </div>
	                    <div class="form-group">
	                        <label>Kecamatan</label>
	                       	<select class="form-control input-sm" name="kd_kecamatan">
	                       		<?php 
	                       			foreach ($kecamatan as $value) { ?>
	                       				<option value="<?php echo $value['kd_kecamatan'] ?>"><?php echo $value['kecamatan'];?></option>
	                       		<?php		
	                       			}
	                       		?>
	                       	</select>

	                    </div>
	                    <div class="form-group">
	                        <label>Puskesmas</label>
	                       	<select class="form-control input-sm" name="kd_puskesmas">
	                       		<?php 
	                       			foreach ($puskesmas as $value) { ?>
	                       				<option value="<?php echo $value['kd_puskesmas'] ?>"><?php echo $value['puskesmas'];?></option>
	                       		<?php		
	                       			}
	                       		?>
	                       	</select>

	                    </div>
	                    <div class="form-group">
	                        <label>Kode Wilayah</label>
	                       	<input class="form-control input-sm" name="kd_wilayah" type="text" placeholder="Kode Wilayah">
	                       
	                    </div>
		            </div>		                   
                    <div class="box-footer">
                         <button type="submit" class="btn btn-sm btn-primary btn-flat"><i class="fa fa-floppy-o"></i> Simpan</button>
                    </div>
								<?php echo form_close();?>
		        </div><!-- /.box -->                            
		    </div>
		</div>

		<script>
		$("#form").validate({
			rules: {
				
				kd_kelurahan: {
					required: true
				},
				kelurahan: {
					required: true
				},
				kd_wilayah: {
					required: true
				},
			}
		});
		</script>